mediastinal diseases

Question 1

what are indicators that a lesion is malignant?

Answer 1

anterior and superior areas, older age, symptomatic

Question 2

what are the four Ts?

Answer 2

Thymoma, T-cell rich lymphoma, Teratoma and other germ cell tumors, Thyroid and paraThyroid

Question 3

True Thymic hyperplasia vs follicular

Answer 3

true- increase in all elements (epithelial and lymphocytic) so weight of organ is increased. Usually a rebound from stessful event.
Follicular- Increase in B and T cells resulting in lymphoid follicle formation. Associate w/ myasthenia gravis

Question 4

Thymoma description and WHO classification

Answer 4

Older people. Associate w/ Myas. grav.
WHO: A-spindle cell, not very invasive
B1<B3 ratio of epitheliod to spindle (poorer prognosis. C-thymic carcinoma

Question 5

Masaoka Staging

Answer 5

for thymoma. Stage1: completely w/in capsule. Stage2: into adjacent tissue. Stage3: into adjacent organs. Stage4: metastasis.

Question 6

Rx of thymomas

Answer 6

Stage1-surgery. Stage2/3-surgery and maybe chemo. Thymic carcinomas treated more like carcinoma than thymoma

Question 7

What are the three types of lymphomas and where? Rx?

Answer 7

Anteriosuperior. Hodgkins, Acute Lymphoblastic Leukemia/Lymphoma, Large cell (B-cell type) lymphoma. Rx w/ chemo (severe) or radiation but not surgery

Question 8

Hodgkins Disease

Answer 8

Young females. Good prognosis if not bulky. Reed-Sternberg cells with large mirrored nuclei

Question 9

T-cell Acute Lymphoblastic Leukemia/Lymphoma

Answer 9

children, males. Rapidly progress to involve blood and bone marrow. Small lymphocytes with little cytoplasm. Not good prognosis

Question 10

B-cell type large cell lymphoma

Answer 10

young females

Question 11

Germ cell tumors and subtypes

Answer 11

anterior, children. Teratoma, germinoma (seminoma), Mixed GCT

Question 12

Teratoma

Answer 12

Prognosis better for children and mature tumors. Usually benign (mature)

Question 13

Germinoma (seminoma)

Answer 13

young adults, almost exclusively males. Good prognosis

Question 14

Neuroendocrine tumors

Answer 14

carcinoid appearance. often secrete hormones (ACTH in Cushings). Salt and pepper chromatin and Rosette formation

Question 15

Neurogenic tumors: location and types

Answer 15

Posterior mediastinum. Neurilemoma (schwannoma), neurofibroma, ganglioneuroma

Question 16

Schwannoma (neurilemmoma)

Answer 16

mixture of Antoni A areas (cellular with Verocay bodies) and Antoni B areas (vascular and hypocellular0

Question 17

Neurofibroma

Answer 17

Pathognomic of neurofibromatosis type 1. (malignant)

Question 18

ganglionneuroma

Answer 18

Diarrhea due to Vasoactive intestinal peptide (VIP)

Question 19

Thymic Cysts

Answer 19

Children-congenital, unilocular, symptomatic.

Adults-acquired (associated w/ hodgkins, thymoma, surgery), multilocular, asymptomatic. Histo: cholesterol clefts

Question 20

Three diseases of Anterior and middle mediastinum

Answer 20

Chronic fibrosing mediastinitis, infection granulomas, sarcoidosis

Question 21

Chronic Fibrosis Mediastinitis

Answer 21

Two forms: 1) infectious lymhadenitis (histoplasmosis) or other rupturing cysts and granulomas. 2)IgG type 4 (noninfectious). Rx: steroids

Question 22

Sarcoidosis

Answer 22

idiopathic systemic granulomatous disease. Non caseating granulomas with giant cells